User:SPACKlick/sandbox2

Position of medical organizations
electronic cigarettes have not been approved for helping people quit smoking by any government. In July 2014, a report produced by the World Health Organization (WHO) for the Conference of the Parties to the WHO Framework Convention on Tobacco Control, found there was not enough evidence to determine if electronic cigarettes can help people quit smoking. It suggested that smokers should be encouraged to use approved methods for help with quitting. But the same report also mentioned expert opinions in scientific papers that suggested e-cigarettes may have a role helping people quit who have failed using other methods. A previous WHO statement from July 2013 stated that e-cigarettes have not been shown to be effective helping people quit smoking. It also recommended that "consumers should be strongly advised not to use" e-cigarettes unless a reputable national regulatory body has found them safe and effective. The World Lung Foundation applauded the 2014 WHO report's recommendation for tighter regulation of e-cigarettes due to concerns about the safety of e-cigarettes and the possible increased nicotine or tobacco addiction among youth.

The UK National Health Service has concluded, "While e-cigarettes may be safer than conventional cigarettes, we don't yet know the long-term effects of vaping on the body. There are clinical trials in progress to test the quality, safety and effectiveness of e-cigarettes, but until these are complete, the government can't give any advice on them or recommend their use."

In 2014, the US Food and Drug Administration (FDA) concluded, "E-cigarettes have not been fully studied, so consumers currently don't know: the potential risks of e-cigarettes when used as intended, how much nicotine or other potentially harmful chemicals are being inhaled during use, or whether there are any benefits associated with using these products. Additionally, it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death."

Smoking cessation
, research on the safety and efficacy of e-cigarette use for smoking cessation is limited. Their benefit in helping people quit smoking is uncertain. The evidence suggests that e-cigarettes can supply nicotine at concentrations that are, at least partially, enough to substitute for traditional cigarettes. While there are some reports of improved smoking cessation, especially with intensive e-cigarette users, there are also several studies showing a decline in cessation in dual users. A 2014 Cochrane review found limited evidence of a benefit as a smoking cessation aid from a small number of studies. A 2015 review found variable quality evidence that nicotine-containing e-cigarettes were associated with smoking cessation and reduction from a limited number of studies. A 2015 review concluded that while they may have a benefit for decreasing cigarette use in smokers, they have a limited benefit in quitting smoking. A 2014 review found e-cigarettes may have some potential for reducing smoking.

Two 2014 reviews found no evidence that e-cigarettes are more effective than existing nicotine replacement treatments for smoking cessation. Studies have not shown that e-cigarettes are superior to regulated medications for smoking cessation. A 2014 review found four experimental studies and six cohort studies that indicated that electronic cigarettes reduced the desire to smoke and withdrawal symptoms. This review also noted that two cohort studies found that electronic cigarettes led to a reduction in the number of cigarettes smoked per day. Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. A 2014 review concluded that the adverse public health effects resulting from the widespread use of e-cigarettes could be significant, in part due to the possibility that they could undermine smoking cessation. This review therefore called for their use to be limited to smokers who are unwilling or unable to quit. A 2014 review found that the research suggested that personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes. However, e-cigarettes could have a broad adverse effect for a population by expanding initiation and lowering cessation of smoking. A 2014 review found that the evidence suggests that "e-cigarettes are not associated with successful quitting in general population-based samples of smokers."

Safety
The risks of electronic cigarette use are uncertain, as there is little data regarding health effects, and considerable variability between vaporizers and in the composition, concentration and quality of their liquid ingredients and thus the contents of the aerosol delivered to the user. The limited evidence suggests that e-cigarettes are probably safer than traditional cigarettes. Various methodological issues, conflicts of interest, and often inconsistent research has been identified in the research regarding e-cigarettes. However, e-cigarettes cannot be regarded as simply harmless. A 2014 review recommended that e-cigarettes should be regulated for consumer safety.

One review found they appear to be similar in toxicity to other nicotine replacement products, but there is not enough data to draw conclusions. Another found that the evidence suggests that the US Food and Drug Administration (FDA) accepted products such as a nicotine inhaler are probably a safer way to supply nicotine than e-cigarettes. A July 2014 WHO report cautioned about potential risks of using electronic cigarettes. The report concluded that "the existing evidence shows that ENDS aerosol is not merely "water vapour" as is often claimed in the marketing for these products. ENDS use poses serious threats to adolescents and fetuses." There are also risks from misuse or accidents (e.g., accidental fires caused by vaporizer malfunction, other vaporizer design issues, or accidental contact with liquid nicotine). A 2014 systematic review concluded that the risks of e-cigarettes have been exaggerated by health authorities and stated that it is apparent that there may be some remaining risk accompanied with e-cigarette use, though the risk of e-cigarette use is likely small compared to smoking tobacco. A 2014 Cochrane review found no serious adverse effects reported in trials. Less serious adverse effects from e-cigarette use can include throat and mouth inflammation, vomiting, nausea, and cough. , the short and long term effects from using e-cigarettes remain unclear. E-cigarette users are exposed to potentially harmful nicotine.

Tobacco harm reduction has been a controversial area of tobacco control. The health community have been reluctant to support harm reduction efforts, in part in response to tobacco industry deception. A 2014 review found no long-term evidence on the efficacy of e-cigarettes in reducing harm from tobacco related disease or improving the health of the population as a whole and concluded promotion of e-cigarettes as a harm reduction product was premature. A different review found e-cigarettes would likely be less harmful than tobacco cigarettes to users and bystanders, if at all. The authors warned against the potential harm of excessive regulation and advised that health professionals may consider advising smokers who are reluctant to quit by other methods to switch to e-cigarettes as a safer alternative to smoking. A 2014 review argued that regulations for electronic cigarettes should be similar to those for dietary supplements or cosmetic products to not limit their potential for harm reduction. A 2012 review found electronic systems appear to generally deliver less nicotine than smoking, raising the question of whether they can effectively substitute for tobacco smoking over a long-term period. A 2012 review found e-cigarettes could considerably reduce traditional cigarettes use and they likely could be used as a lower risk replacement for traditional cigarettes, but there is not enough data on the safety and efficacy to draw definite conclusions. E-cigarette use for risk reduction in high-risk groups such as people with mental disorders is unavailable.

Smoke from traditional tobacco products has 40 known carcinogens among the 10,000 chemicals it contains, none of which has been found in more than trace quantities in the cartridges or aerosol of e-cigarettes. A 2011 review stated that while e-cigarettes can not be considered "safe" because there is no safe level for carcinogens, they are doubtless safer compared to tobacco cigarettes. Any residual risk of e-cigarette use should be weighed relative to the risk of continuing or returning to smoking, taking account of the low success rate of currently-approved smoking cessation medications. Adults most frequently use electronic cigarettes as a replacement for tobacco, but not always to quit. Although some people have a desire to quit smoking by using e-cigarettes, another common explanation for the use of these products is to cut back on traditional cigarettes.

In 2014 a report commissioned by Public Health England concluded that there is large potential for health benefits when switching from tobacco use to other nicotine delivery devices such as electronic cigarettes, but realizing their full potential requires regulation and monitoring to minimize possible risks. They found that the evidence suggests that a considerable number of smokers want to reduce harm from smoking by using these products. The British Medical Association encourages health professionals to recommend conventional nicotine replacement therapies, but for patients unwilling to use or continue using such methods, health professionals may present e-cigarettes as a lower-risk option than tobacco smoking. The American Association of Public Health Physicians (AAPHP) suggests those who are unwilling to quit tobacco smoking or unable to quit with medical advice and pharmaceutical methods should consider other nicotine containing products such as electronic cigarettes and smokeless tobacco for long term use instead of smoking. In an interview, the director of the Office on Smoking and Health for the U.S. federal agency Centers for Disease Control and Prevention (CDC) believes that there is enough evidence to say that using e-cigarettes is likely less harmful than smoking a pack of conventional cigarettes. However, due to the lack of regulation of the contents of the numerous different brands of electronic cigarettes and the presence of nicotine, which is not a benign substance, the CDC has issued warnings. A 2014 WHO report concluded that some smokers will switch completely to e-cigarettes from traditional tobacco but a "sizeable" number will use both tobacco cigarettes and electronic cigarettes. This report found that such "dual use" of e-cigarettes and tobacco "will have much smaller beneficial effects on overall survival compared with quitting smoking completely."

Addiction
A number of organizations have concerns that e-cigarettes might increase addiction to and use of nicotine and tobacco products in the young. These include the Centers for Disease Control and Prevention, the International Union Against Tuberculosis and Lung Disease, the American Academy of Pediatrics and the Food and Drug Administration. The World Health Organization raised concern of addiction for nonsmokers from their use in July 2013. The National Institute on Drug Abuse stated that there is a possibility that they could promote continuation of addiction to nicotine in those who are attempting to quit.

It is not clear whether using e-cigarettes will decrease or increase overall nicotine addiction. The information concerning the drug action of the nicotine in e-cigarettes is limited. The evidence suggests that the nicotine in e-cigarettes is adequate to sustain nicotine dependence. The limited data suggests that the likelihood of abuse from e-cigarettes could be smaller compared to traditional cigarettes. A 2014 systematic review found that the concerns that e-cigarettes could cause non-smokers to begin smoking are unsubstantiated. A 2014 review found no evidence that they are used regularly by those who have never smoked, while another 2014 review has found that in some populations nearly up to a third of youth who have ever used electronic cigarettes have never smoked traditional cigarettes. No long-term studies have been done on the effectiveness of e-cigarettes in treating tobacco addiction. The degree to which teens are using e-cigarettes in ways it is not intended to be used, such as increasing the nicotine delivery, is unknown. The extent to which e-cigarette use will lead to abuse in youth is unknown. The impact of e-cigarette use by children in respect to substance dependence is unknown. Some evidence suggests that dual use of e-cigarettes and traditional cigarettes may be associated with greater nicotine dependence.